CHILDCARE

CHILDCARE – provision of essential healthcare services to a child client.

Objective: to be able to perform all principles of caring to a child.

3 Important persons in Childcare:

1. CHILD
 a.k.a “care receiver”, “care recipient”
 the one who receives/enjoy the services of the caregiver.
2. EMPLOYER
 The one who hires the caregiver
 The one who has the final say on things relevant to the care of the client.
3. CAREGIVER
 Trained, matured, competent individual who is tasked to maintain the good health condition, safety
& welfare of the child/elderly client.

CAREGIVING- genuine, love, care, understanding and meeting the needs of individual.
CARING- an act of helping, guiding and counseling.
RIGHTS – a lawful act that one should enjoy & expect from the others.

A. CAREGIVER RIGHTS
1. Rights to have a day off.
2. Rights to enjoy privileges.
3. Rights to receive salary on time.
4. Rights to refuse to care if the caregiver felt the situation is unsafe or treated unfairly.
5. Rights to know all important things necessary for the client care.
6. Rights to privacy & confidentiality.
B. CHILD RIGHTS
1. Rights to play, rest & leisure.
2. Rights to access to healthcare services.
3. Rights to be protected from cruelty, abuse & exploitation.
4. Rights to quality education.
5. Rights to development & survival.
6. Rights to have their basic needs met.
7. Rights to have to say in their own life.
C. EMPLOYER
1. Rights to privacy & confidentiality.
2. Rights to be confident that the caregiver has a positive attitude towards children.
3. Rights to terminate the caregiver in terms of grievances & negligence.

RESPONSIBILITIES – an act of providing concern & protection to oneself & towards another.

A) EMPLOYER RESPONSIBILITIES
1. Responsible in honoring all agreement made with the caregiver concerning his/ her employment.
2. Responsible to issue certificate of employment.
3. In some cases, responsible in providing caregivers transportation.
4. Responsible in providing all important information needed for client care.
B) CAREGIVER RESPONSIBILITIES
1. Responsible in providing safety & security.
2. Responsible in knowing all important telephone/emergency numbers.
3. In case you do not know a certain procedure, ask your employer.
 4. Prioritize your client before anything else.
5. Care appropriately according to your client age.
6. Report to your client immediately cases of accident/emergency.
7. Do not discuss your client condition to another person.

4 MAJOR CONTEXTS OF CHILDCARE

1. Maintenance of safety & security
2. Provision of comfort
3. Foster confidence
4. Maintenance of health

MOST EFFECTIVE QUALITIES OF A CAREGIVER

1. Good listener
2. Know how to control temper
3. Honest & trustworthy
4. Competent
5. Dependable
6. Patient
7. Sensitive to the needs and feelingsof others

BASIC MENSURATION & APPROVED MEDICAL ABBREVIATION

AC Before Meal
PC After Meal
AM Morning
PM Afternoon
OD Once a day
BID Twice a day
TID 3x a day
QID 4x a day
UE Upper Extremities
BP Blood Pressure
RR Respiratory Rate
CPM Cycles Per Minute
BPM Beats Per Minute
PRN When necessary
NPO Nothing by mouth
mmHg Millimeter mercury
PT Physical Therapist
VS Vital Sign
S/Sx Signs & Symptoms
TSB Tepid Sponge Bath
TPR Temperature, Pulse, Respiration
PR Pulse Rate
ADL Activities of Daily Living
Rx Prescription
Px or Pt Patient
c/o Complain of
c/c Chief complain
® Right
L Left
c With
s without
 C degrees Celsius
F degrees Fahrenheit

EQUIVALENT MEASUREMENT

A) Length
1 inch = 2.54 cm
1 foot = 12 inches
1 yard = 36 inches
B) Weight
1 kg. = 2.2 lbs. = 1,000 g
C) Volume
1 oz = 30 ml
1 tsp. = 5 ml
1 tbsp. = 15 ml
D) Temperature
100 C = boiling pt.
0 C = Freezing pt.

Conversion:
F = C*9/5+32
C = F*5/9-32

PREGNANCY & GIVING BIRTH

PREGNANCY
 Voyage is unknown
 Gestational stage
 9 mos.
 36-38 months

SIGNS & SYMPTOMS

1. Missed menstruation
2. Tenderness of the breast
3. Increase vaginal discharge
4. Frequent urination
5. Nausea, vomiting/morning sickness
6. Fatigue, restlessness & dizziness
7. Food craving

STAGES OF PREGNANCY
1. FERTILIZATION – when egg cell meets the sperm cell
2. ZYGOTE – egg cell & sperm cell formed a single cell
3. BLASTOCYST – single cell breaks into a multiple cell
4. EMBRYO – 1st 8 weeks/ 2 mos. Of pregnancy
5. FETUS – 2nd month - birth

FEMALE REPRODUCTIVE SYSTEM

1. VAGINA - muscular birth canal.
2. UTERUS - hollow muscular structure, a.k.a “the womb” inside is where the fetus is developed.
3. CERVIX- the neck of the uterus
 4. PLACENTA - large, spongy flat organ attached to the wall of uterus. It supplies the fetus with nutrients and
oxygen.
5. AMNIOTIC SAC - fluid fille sac contained inside the placenta & uterus.
6. AMNIOTIC FLUID- liquid that surrounds & protect the fetus inside the sac.
7. UMBILICAL CORD- a rope like structure that contain blood vessel & connected fetus from the placenta.

EMERGENCY CHILDBIRTH - an emergency delivery of the baby when no helath care professional is available.
MISCARRIAGE - premature expulsion of fetus from a natural cause.
ABORTION - to remove the content of the uterus, through the vagina using drugs thats stimulate contraction of
the uterus, so that the content will be removed.
LABOR – a process in which the body prepare itself for the delivery of the baby.

SIGNS OF LABOR
1. Regular rhythmic contraction
2. Appearance of bloody show
3. Breaking of Amniotic bag

STAGES OF LABOR
1. Opening of the cervix
2. Delivery of the baby
3. Delivery of placenta

LITHOTOMY POSITION OR DORSAL RECUMBENT- position of the mother when giving birth,the patient lies on
the back with the legs well separated, thighs acutely flexed on the abdomen, and legs on thighs.

TYPES OF BIRTH
1. NORMAL DELIVERY – Lithotomy position/dorsal recumbent position.
2. CESARIAN – an incision is done either horizontal/traverse

REASON:
a. Breech presentation
b. Twins
c. Fetal distress syndrome
3. LAMAZE METHOD – the husband stays beside the mother & try to help & comfort the mother.
4. LE’ BOYER METHOD – the method believes that the baby should be born in a peaceful, quiet & dim light
environment.

PREPARATION FOR EMERGENCY DELIVERY

1. Prepare all the necessary materials.
2. Try to get help.
3. Prepare the mother for the delivery.
A. Provide comfort & privacy
B. Let the mothering her position of comfort (side-lying)
C. If about the give birth, place the mother in supine position (knees & hips bended)
D. Place clean/plain towel on the buttocks area.
E. Cover the body of the mother. (blanket/towel)

FIRST AID DURING EMERGENCY DELIVERY

1. Assist the mother.
2. Protect the mother & the baby until help arrives.
3. Send all the parts of the placenta & layer of amniotic sac to the hospital.
CARE FOR THE NEWBORN:
1. Record the time of birth.
2. Keep the baby on the mother side with head slightly lower than the body to help drain & clear mucus from
the face.
3. Wipe the baby’s face to clear the mucus from the airway (nose to mouth).
4. If the baby is not breathing, gently tap the sole of the feet, if it still no sign of respiration do CPR.
5. If the baby is breathing & the cord stop pulsating, dry the baby w/ towel but do not remove the slippery
coating.
6. Keep the baby warm as you continue to watch his breathing pattern.
7. Never attempt force delivery placenta.
8. Send to hospital all parts of the placenta

ASSESSMENT OF A NEWBORN:

1. APGAR TEST/APGAR SCORING

 An immediate evaluation to a newborn, done on the 1st minute after birth & repeated after 5 mins.,
to determine the general conditioning of the baby.
 By Dr. Virginia Apgar

0 1 2
Appearance Cyanotic-bluish Body is pink Pink all over
(color of the discoloration
skin) all over body
Pulse Absent >100 bpm < 100 bpm
(heartbeat)
Grimace No response Weak cry Strong cry
(irritability)
Activity Absent Some Active
(muscle flexion of movement
tome) extremities of
extremities
Respiration Absent Irregular regular
(regularity of
breathing)

Interpretation:
7-10 : good condition
4-6 : fair but guarded
0-3 : poor condition, need suctioning, resuscitation & oxygenation.

2. NEWBORN SCREENING TEST

 A simple procedure, thru the “heel prick method”, to draw blood from the baby to determine if the
newborn has congenital metabolic disorder w/c can lead to mental retardation & even death if left
untreated.
 Congenital Hypothyroidism – decrease or absence of thyroid hormones w/c is necessary
for the growth & dev’t. of the brain.
 Deficiency can lead to mental retardation.
3. REFLEX
 Involves involuntary response to an applied stimulus.
 General significance of reflex is an indication of normal development of the central nervous system.
 Primitive Reflex – reflex that are present @ birth but slowly represses as we grow old.
 Reflex Stimulus Response Significance Maturation
Rooting Touch the Turn the Help the 5 mos.
Reflex corner of head to body to
the mouth the search for
either direction of nipple for
side the feeding
stimulus purposes
Sucking Mouth Sucking For feeding 5-6 mos.
Reflex comes in motion w/ purposes
contact throat &
w/ the tongue
nipple swallowing
motion
Swallowing Substance Swallowing Intake of 5-6 mos.
Reflex placed on motion food & milk
the to prevent
posterior choking
part of
the
tongue
Extrusion Substance Extrusion Prevent 5-7 mos.
Reflex placed on substance swallowing
the of edible
anterior substance
part of
the
tongue
Moro Sudden Arms Normal 6-7 mos.
Reflex neck extension, dev’t. of
(Startle extension abduction the CNS
Reflex) or a loud & bringing (Central
noise the arms Nervous
against the System)
mid-line
Tonic Neck Turn the Extension Normal 5 mos.
Reflex head to of the dev’t of the
(Fencing either extremities CNS
Reflex) side L/R on the chin
side &
flexion on
the skull
side
COMFORTS FOR INFANTS & TODDLERS

INFANT
COMMON BEHAVIOR: COMMON REASON WHY WAYS TO SOOTHE A NEWBORN:
1. fequent sleeping BABY CRY: 1. offer feed
2. frequent yawning 1. illlness 2. cuddle the client
3. fequent hiccups 2. nappy rash 3. rock the client rhythmitically
4. frequent urination & defecation 3. colic (kabag) 4. swaddle
5. frequent sneezing 4. his sorrounding 5. pat
6. prone to hypothermia 5. activities he hates 6. give something to suck
7. passage of meconium (first 6. your mood 7. divert the attention
stool) 7. too much fussing
8. cross-eye tendency
9. presominated by flexor tone
10. predominated by primitive
reflex
11. no tears when crying

TODDLER
Common behvior Causes Cga manfestation
1. Hyperactive
2. Very curious
3. playful
4. RITUALISTIC 1. expose your client to frequent changes
BEHAVIOR - 2. when employing new things acquaint
regular routines your client first with a transition period
that are comforting
to the baby.
5. TEMPER 1. hungry 1. divert the attention of your client MANIFESTATION
TANTRUMS - 2. sleepy 2. ignore the client for a moment but be 1. high pitch cry
physical 3. sick sure your client is safe 2. throwing toys
aggression in 4. fatigue 3. remove the child immediately from the 3. kick a lot
response to 5. stress cause of tantrum. 4. nail biting
frustrations 4. don't give-in to all of his demand 5. head banging
5. do not bribe your client 6. breath holding
6. be calm & must not over react
7. bring the child in a private room & talk
to him up to the level of his
understanding.
6. NEGATIVISM - 1. "no" is the CGA (GENERAL)
a.k.a "CHILD word they always 1. orient the clild with the word "YES"
REFUSAL"; endless hear 2. offer choices
"NO" 2. to test your 3. don't ask question answerable by yes
authority or no

CGA for Negativism DURING

MEALTIME
1. offer choices
2. incorporate food crafting
3. allow him to use his favorite utensil
4. incorporate short stories
 5. be a role model

CGA for Negativism DURING BATH

TIME
1. incorporate short stories
2. give some floating toys
3. allow them to use a favorite towels

CGA for Negativism DURING

SLEEPING TIME
1. tell some bed time stories
2. play lullaby songs
3. give some back masage
4. give your client a glass of milk
5. join the client in sleeping

7. DAWDLING - REASON: 1. use simple word & give simple

slowness in carrying 1. child does not command one @ a time.
out an activity undertand your 2. do not criticize the child for a failure
request request.
2. the child is 3. make sure the child understand the
limited only request.
3. the child is sick 4. do not ask the child to do things
or tires beyond his capacity.
8. SIBLING RIVALRY 1. unfair 1. avoid comparison MANIFESTATION
- simply jealousy treatment 2. orient the clied for the upcoming baby 1. tendency to hit the baby
towards another 2. lack of 3. don't scold your client in front of the 2. grabbing of milk formula
sibling attention baby.
4. alow your client to join in the
grooming activities of the baby

1. STEALING - to take
something w/out
permission.
1. ENVY & JEALOUSY
ENVY - desire for another
possession
JEALOUSY - more of
emotional feeling
PRE-SCHOOLER
Causes: CGA:
1. misguided generosity 1. once you caught the child tell him to return the object
2. take it as a challenge 2. tell about the "GOLDEN RULE"
3. form of revenge 3. Be a role model
4. teach the child the concept of ownership
trust the child if he promises he will not do it again
Causes: CGA:
1. unfair treatment 1. set a good example
2. socio-economic status 2. give gifts w/ common appreciation w/ everybody
3. advice your client to live in accordance to the afford
lifestyle of the family
4. avoid comparison

3. MASTURBATION - self Causes: CGA:

stimulation of the genitals 1. unresolved conflict 1. divert attention
but w/out malice, normal 2. boredom or lack of 2. give some constructive activities
part of growth & dev't but interest 3. assess further the reason
should not be done 3. castration anxiety 4. don't scold your client
excessively.

4. HYPERACTIVITY & Causes: CGA:

NAUGHTINESS 1. no imposed rule
2. the parents use
permissive type of
discipline
1. set reasonable rules
2. tell your client stories about hero who
practice/exercise self control
3. let them work or play in a place with least possible
noise
4. teach them to admit mistake & apologize
5. they love to ask question
6. they tend to imitate others

SCHOOLER
Common Behavior: CGA:
1. tends to be moody 1. avoid comparison
2. hero worship 2. be a role model
3. fond of collecting items 3. for bully client, tell him the consequences of his
4. stealing & lying is common behavior
5. bully aggressor age
6. gang age
7. love to peer with same sex
8. companionship is more important than play
9. boisterous when they are bored

ADOLESCENT
Common Behavior: CGA:
1. bothered by the statement "WHO AM I?" 1. encourage your client to epress his feelings through
2. group oriented conversation
3. attraction to opposite sex 2. let your client be aware of his sorrounding
4. emotionaly sensitive 3. develop a close bonding with your client
5. tends to rebel against the authority
6. problem age
7. tends to masturbate

COMMON RISK TAKING BEHAVIOR OF AN

ADOLESCENT
1. youth in conflict with the law
2. use and abuse of drugs
3. early pregnancy

OTHER COMMON BEHAVIORAL PROBLEM OF

CHILDREN
1. spitting
2. destructiveness
3. bad language
4. thumb sucking
VITAL SIGNS
 A.k.a “Cardinal Signs”, “Signs of Life”
 Reflects functions of the 3 important body processes for life.

3 Important Body Processes:

1. Body temperature
2. Respiration
3. Heart function (pulse, blood pressure)
BODY TEMPERATURE
 Refers to hotness/coldness of the body.
 Balance between heat loss & heat produced by the body.

FACTORS AFFECTING BODY TEMPERATURE:

1. Age – Elderly: 35.5 C – 36.8 C
Infant: 36.5C – 37.5C
2. Gender/Sex – female has higher body temperature @ puberty
3. Environment
4. Activities
5. Time of the Day

Diurnal Variation:
a) 2am – 6am: lowest body temp.
b) 8pm – 12mn: highest body temp.

THERMOMETER – instrument used to measure the body temperature.

METHODS IN TAKING TEMPERATURE:

1. RECTAL/ANAL METHOD: most accurate
2. ORAL METHOD: most convenient
3. AXILLARY METHOD: most safe

RESPIRATION – act of breathing in & out of the lungs.

HOW TO ASSESS RESPIRATION:

1. RATE: CPM (cycles per minute)
2. QUALITY/CHARACTER: sound of breathing
3. RHYTHM: regularity of breathing
4. DEPTH: deep, shallow breathing pattern

FACTORS AFFECTING RESPIRATORY RATE:

1. Age
2. Activities
3. Altitude
4. Medication
5. Environment

HEART FUNCTION – wave of blood created by contraction of left ventricles.

FACTORS AFFECTING PULSE RATE:

1. Hormones
2. Hemorrhage
3. Age
4. Activities
 5. Medication
6. Stress
7. Change of position

BLOOD PRESSURE – measures the pressure by the body as it pulsates through the artery.

SPHYGMOMANOMETER – instrument used to measure blood pressure.

GROWTH & DEVELOPMENT

GROWTH
 Progressive increase in physical size.
 A.k.a “Quantitative Change”
 E.g. height, weight

DEVELOPMENT
 Progressive increase in physical, mental & social skills.
 A.k.a “Qualitative Change”
 E.g. walking, identification of name, solving problem, social interaction

FACTORS AFFECTING GROWTH & DEVELOPMENT:

1. HEREDITY – genetic qualities we inherit from our parents.
2. ENVIRONMENT – Pre-natal: before birth
Post-natal: after birth
3. NUTRITION

4 MAJOR FOOD GROUPS OF CANADA:

1. GRAIN GROUP – source of carbohydrates; for energy; rice, cereal etc.

2. MEAT/POULTRY GROUP – source of protein; building block of body tissue; fish, chicken, pork, beef etc.
3. MILK & DAIRY GROUP – source of calcium; for stronger teeth & bones; milk, ice cream, yogurt etc.
4. FRUITS & VEGETABLES GROUP – source of vitamins & minerals; regulates different body processes;
apple, cabbage, oranges, spinach, etc.

PRINCIPLES OF GROWTH & DEVELOPMENT:

1. Each child is unique.
2. Each child resembles w/ one another.
3. Growth & development is a lifelong process.
4. All body parts & system do not grow at the same time.
5. Growth & development follow a certain direction.
a) Cephalocaudal (head to foot)
b) Proximodistal (from the center to peripherals)
c) Simple to complex
6. Children are competent.
7. Discontinuation of growth – growth gap years (schooler stage)
Stages of Fast Growth Rate:
a) Infancy Stage
b) Adolescent Stage

DEVELOPMENTAL MILESTONE – significant event in children’s development.

2 MOTOR SKILLS
 1. FINE MOTOR SKILLS
 Uses small muscle of the body to produce movement.
 E.g. of muscle are: facial muscle, hands & fingers muscle etc.
 E.g. of movement: writing, smiling, etc.

1 yr. old - lines

2 yrs. Old - figure w/out direction
3 yrs. Old - circle
4 yrs. Old - cross
4 ½ yrs. Old - square
5 yrs. Old - triangle
6 yrs. Old - figure of a man

2. GROSS MOTOR SKILLS

 Uses big muscle of the body to produce movement.
 E.g. of muscles are: back muscle, leg muscle etc.
 E.g. of movement: walking, running, etc.

5 mos.: supine to prone

6 mos.: prone to supine
8 mos.: creeping
9 mos.: crawling
10 mos.: cruising

LANGUAGE DEVELOPMENT

1 month : makes a throaty sound; cries when hungry

2 months : social smile; make a giggling sound
3 months : gurgles, coos & listen to music
4 months : laugh loud
5 months : say one syllable
6 months : can make their own sound
7 months : Echolalia (repeat what they hear)
8 months : learn the meaning of action
9 months : say 2 syllable words
10 months : “peek-a-boo”
11 months : speak 1 or 2 words
12 months : can join singing

PRINCIPLE OF LANGUAGE TRAINING

1. Do not baby talk.

2. Teach one language at a time.
3. Make an eye to eye contact.
4. Talk w/ clear words.
5. Give instruction as simple as possible.

5 STAGES OF GROWTH & DEVELOPMENT (printed separately)

1. INFANCY STAGE - (0-12 months)
2. TODDLER STAGE - (1-3 yrs old)
3. PRE-SCHOOLER AGE (3-6 yrs old)
4. SCHOOLER AGE STAGE (6-12 yrs old)
5. ADOLESCENCE (12-18 y/o girls; 12-21 y/o boys)

INFANCY STAGE
 Shortest stage
 Newborn (1st 24hrs)
 Neonate (1st month)
 The infant is a.k.a “THE BOSS OF THE HOUSE”

STAGES OF DESCRIPTIVE PHYSICAL FEATURES &

PHYSICAL GROWTH
GROWTH & DEV'T TERMS CHARACTERISTICS
INFANCY STAGE  Shortest stage 1. Head is relatively larger than the 1) Average Body Weight:
 Newborn (1st body 7-75 lbs.
24hrs) 2. round face 2) Average Birth Height:
 Neonate (1st 3. round chest 50-53 cm.
month) 4. prominent abdomen 3) Average Head
 The infant is a.k.a 5. nails are soft & so the skin Circumference: 35 cm
“THE BOSS OF 6. LANUGO - fine dry hair that (hc)
THE HOUSE” covers the skin mostly @ the back 4. Average Chest
of ears, face & shoulder Circumference: 33 cm
7. VERNIX CASEOSA - cheesy like (cc)
substance usually found @ the
skin creases & folds; disappear
1-2 wks after birth
8. MILIA - tiny white spots, look like
a white heads found on the nose,
forehead & chin
9. CRADLE CAP - scaly skin on the
top of the head
10. Genetals are swollen
11. CYANOSIS - bluish discoloration
of the skin due to lack of oxygen
int the body.
12. JAUNDICE - yellowish
discoloration of the body.
2 Types of Jaundice:
a) Physiological - normal, it
appears 3-4 days after birth
b) Pathological - abnormal
condition of the body.

13. MONGOLIAN SPOTS - bluish,

grayish spots usually @ the
lower back/buttocks area w/c
fades on preschooler stage
w/o treatment.
14. FONTANELS/FONTANELLES -
- soft spot on the top of the
head that give space for the
brain to grow & develop.
 2 Types of Fontanels:
a) Anterior Fontanels - diamond
shape, close @ 18 mos.
b) Posterior Fontanels -
triangular shape, close to 2-4 mos.

TODDLER STAGE 1. Curiosity stage 1. Chin is not yet profound 1. Body weight x 2: 6 mos.
 comes from the 2.Terrible two's stage 2. Chubby appearance w/ short arms (ave. weight)
word "TODDLE" 3. Hyperactive stage & legs 2. Body weight x 3: 1 yr.
w/c means to walk w/ 4. Baby hood stage 3. Protruded abdomen old (ave. weight)
short unsteady 5. Cute little thing 4. Lordotic posture 3. Body weight x 4: 2 yrs.
steps. stage 5. Bowlegged Old (ave. weight)

 Very wonderful x 2 the height of a 2 yr.

stage old = ave. adult
height

PRESCHOOLER 1. According to 1. Chin is more profound

STAGE parents - early 2. Longer extremities
childhood stage 3. Head comes more in line w/ the
2. According to body size
educator - 4. Body becomes cone-shape
preschooler stage 5. Flattened abdomen
3. According to 6. Baby looks disappear
Psychologist
> Pre-gang age 2 Kinds of Body Built:
> Exploratory age 1. Endomorph - Flabby
(catharsis) 2. Mesomorph - sturdy
> Imitative age 3. Ectomorph - thin
> Pugnacious age
(fun of fighting)

SCHOOLER STAGE 1. Troublesome 1. Long arms & legs

2. Sloppy age - tend 2. Trunks become broader
A.k.a “UGLY to be careless 3. Loss of body teeth & appearance
DUCKLING STAGE” about appearance of permanent teeth
3. Critical (personality
dev't) period
4. Quarrelsome age
5. Creative age
6. Gang age
7, Bully aggressor
age (BULLY -
someone who
has an aggressive
reaction pattern
(considerable
physical strength)
ADOLESCENCE 2 Hallmarks of the
STAGE Stage:
> comes from the
word "ADOLESCENE" 1) onset of puberty
w/c means to grow 2) cessation of body
into adulthood growth

3 Stages of
Adolescent:

1) Early Adolescent:
12-14 y/o
2) Middle Adolescent:
15-17 y/o
3) Late Adoslescent:
18-21 y/o

PUBERTY - physical process of change, characterized by the dev't of secondary sexual characteristics.

FEMALE MALE
PRIMARY SEX  vagina  penis
CHARACTERISTICS  ovaries  testes
 fallopian tube  prostate gland
 involves primary  uterus  scrotum
organ for  cervix  seminal vesicles
reproduction  menarche (1st menstruation)  spermache (1st ejaculation)
 wet dreams (a.k.a "nocturnal emission")
SECONDARY  enlargement of breast  voice change
SEXUAL  voice change  prominence of Adam's apple
CHARACTERISTICS  widening of pelvis  skin change
 appearance of pubic hair/axillary  appearance of pubic/axillary hair
 distinguished sexes hair  broadening of shoulder
from each other  height increases  facial hair
but play no part in  skin changes
reproduction

3 MAJOR CHANGES OF ADOLESCENCE STAGE:

1. Biological
2. Physical
3. Psychological

8 DESCRIPTIVE PHRASE:
1. Adolescence stage a transition period.
2. Adolescence stage an important period
3. Adolescence stage a dreaded age
4. Adolescence stage a time for search of identity
5. Adolescence stage a time on unrealism
6. Adolescence stage a threshold to adulthood
7. Adolescence stage a period of change
8. Adolescence stage a problem period
DEVELOPMENTAL THEORY IN PSYCHOLOGY

1. PSYCHOSEXUAL DEVELOPMENTAL THEORY – Dr. Sigmund Freud

2. PSYCHOSOCIAL DEVELOPMENTAL THEORY – Erik Erikson

3. COGNITIVE DEVELOPMENTAL THEORY – Jean Piaget

PSYCHOSEXUAL DEVELOPMENTAL THEORY

SIGMUND FREUD

 Austrian psychiatrist & neurologist

 He believes that people are born in a biological drive that must be redirected so as to be able to live in
society.
 He also believes that sexual pleasure shift from one body zone to another.
 “Father of Psychoanalysis”
 Propose 3 Hypothetical Part of Personality:
1. ID - “Pleasure Principle”; immediate satisfaction of instinctual need.
2. EGO – “Reality Principle”; has the capacity to screen out what is not essential for the moment.
3. SUPEREGO – “Should or Should not Principle; knowing the right from wrong.

INFANCY STAGE TODDLER STAGE

ORAL STAGE ANAL STAGE
> MOUTH is the center of satisfaction > ANUS is the center of gratification

> Primary activity is feeding & crying. > Primary activities are urination & defecation

> Potty Training Stage – teaching the use of potty chair

Oral Stage Fixation:

1. Sarcastic
2. Chains smoker
3. Thumb sucking
4. Nail biting
5. Very talkative

ANAL STAGE FIXATION

ANAL RETENTIVE ANAL EXPULSIVE
PERSONALITY PERSONALITY
Happy in keeping Messy
Tendency to be collector Disorganize/Disorderly
Resistive to changes Wasteful
Obsessive compulsive Stingy
Possessive
 PRE-SCHOOLER SCHOOLER ADOLESCENT
PHALLIC STAGE LATENCY STAGE GENITALIA STAGE
> From the word “PHALUS” w/c means > Dormant Stage > They learn the power of
“Penis” sexuality

> Primary activity is masturbation but

w/out malice

> Electra complex (daughter-father)

> Oedipal complex (son-mother)

COGNITIVE DEVELOPMENT STAGE

JEAN PIAGET (known for pioneering)

COGNITIVE THEORY
 Concern with the development of a person’s thoughts/thinking process, it’s influences, how we understand
& interact with the world.
 Account for the steps & sequence of children intellectual development.

3 INTERRELATED PROCESS OF COGNITIVE GROWTH:

1. ORGANIZATION – gathering of information
2. ADAPTATION – adjusting your knowledge

2 Steps of Adaptation:

a.) Assimilation – thinking something based from his present way of thinking.
b.) Accomodation – adjusting the knowledge based on the special characteristics of the information.

3. EQUILIBRIUM – acquiring a stable balance about the cognitive element.

INFANCY STAGE TODDLER & SCHOOLER STAGE ADOLESCENT STAGE

pRE-SCHOOLER STAGE
Sensorimotor stage Pre-operational Operational thought Formal operation stage
 Stimulation of senses thought stage stage  Abstract thinking
to produce  A.k.a “Trial & error  Logical thinking is  Able to solve
movement. stage”, “symbolic develop complicated problem
 Toys are the best thought stage”  Able to solve simple
stimulant to develop  Egocentric problem
knowledge of children  Cannot comprehend r
 It could persist up to dimensional thinking
18 months
 Learning starts thru
reflexive reaction to
an object & frequent
repetition to an
object performance.
PSYCHOSOCIAL DEVELOPMENTAL THEORY

ERIK ERIKSON
 A German born psychologist who emphasize the influence of society in developing the personality.
 Each stages of life require a balancing of a positive & negative tendency.

STAGE CONFLICT VIRTUE

INFANCY "Basic Trust vs. Mistrust" "Power of Hope"

How to establish Trust:
1. Attend to the infant needs
2. Provide comfort by cuddling
3. Mental conditioning

Basic needs: (NEST)

1. Nutrition
2. Elimination
3. Sleep
4. Temperature
"Power of Will"
TODDLER "Autonomy vs. Shame & Doubt" (SENSE OF INDEPENDENCE)
How to establish Autonomy:
2. Letting your client walk safely.
3. Allown client to do things on his own
PRE-SCHOO
LER "Initiative vs. Guilt" "Power of Purpose"

SCHOOLER "Mastery vs. Inferiority" "Power of Competence"

Mastery - ability to perform various skills
independently

Inferiority - insecurity, low self-esteem

ADOLESCEN
T "Identity vs. Role Confusion" "Power of Fidelity"

DISCIPLINE
 set of rules governing conduct; a way of correcting child’s behavior onto an acceptable manner.

TYPES OF DISCIPLINE

1. AUTHORITATIVE
o Traditional form of discipline where rules and regulation are imposed without any explanation why
those rules are made.
o Child was not given any chance to voice out his opinion about the discipline.
o It gives no reward for good behavior but has a sure punishment for his behavior.

2. PERMISSIVE
o a.k.a “Laizzes’s Faire” which means allow to act.
o Allow the child to experience the consequences of his own act.
o No direct punishment or reward.
 3. DEMOCRATIVE
o Most favorable type of discipline
o Emphasize the rights of a child.
o It gives the child freedom to say about the disciplinary measure.
o Involve 2-way communication.
o It gives rewards to strengthen the good character.
o It gives also punishment.

PRINCIPLE/GUIDELINES IN IMPLEMENTING DISCIPLINARY MEASURE

1. CONSISTENCY – implement disciplinary action exactly as agreed on.

2. TIMING – initiate discipline as soon as the client misbehave.
3. COMMITMENT – follow through with the details of the discipline.
4. UNITY – agree on a plan & are familiar with the details to prevent confusion.
5. FLEXIBILITY- choose a punishment that is appropriate to the severity of the misbehavior.
6. PLANNING – plan punishment in advance.
7. BEHAVIOR ORIENTATION – always disapprove the misbehavior & not the child.
8. PRIVACY - administers discipline in private.
9. UNDERSTANDING – follow discipline with concern for children feeling such as “I am sad that you have to
stay at home because you are grounded for breaking the rules.
10. TERMINATION - once the discipline is administered consider the child as having a “CLEAN PLATE” &avoid
bringing up the incident again.

KINDS OF DISCIPLINE

1. CORPORAL PUNISHMENT
o military type of punishment in which you are inflicting physical pain.
o Not acceptable because you teach the child that violence is ok or normal.
2. SCOLDING – using verbally, abusive language.
3. IGNORING/EXTINCTION – putting space b/w you and the child.
4. TIME-OUT – spending a period of time to implement disciplinary measure.
5. REWARD – a positive approach.
6. REASONING
o state the reason of discipline.
o Explain why such act or behavior is inappropriate.
7. CONSEQUENCES – the child experience the negative result of his misbehavior.

CHILD ABUSE – any act considered to be improper & causes harm or pain to another person.

KINDS OF CHILD ABUSE

1. PHYSICAL ABUSE – visible evidence
2. EMOTIONAL ABUSE – when a child feels scared, neglected or not permitted to feel safe.
3. SEXUAL ABUSE – exist when a child is forced to submit to sexual act because of fear of either physical or
emotional harm.

SIGNS & SYMPTOMS

1. Burn
2. Bruises
3. Human bite
4. Hematoma
5. Head injury
6. Welts from shape
 7. Fracture
8. No eye-contact
9. Scald

REASON FOR ABUSE

1. The abuser has also once abused & learned this type of behavior.
2. The abuser cannot cope up with the stress in handling children.
3. The abuser is not the parents, but the parents is unable to stop the event.

REASON WHY CHILDREN DO NOT REPORT ABUSE

1. Ashamed
2. Do not know whom to call.
3. Do not know any other type of behavior.
4. They are threatened.
5. They feel they deserved it.

GENERAL GUIDELINES
1. Do not compare 1 case with another.
2. Be observant.
3. Look for further sign of abuse.
4. If you suspected an abuse is happening report it to the proper authority.

APPROACHES HOW TO MINIMIZE MISBEHAVIOR

1. Set clear & reasonable rules.
2. Call your client attention as soon as he misbehaves.
3. Keep promise made to children.
4. Structure the environment to prevent difficulties or accident.
5. Praise children for desirable behavior with attention or verbal approval.
6. Teach desirable behavior thru own example & using calm voice.

COMMON FEAR & STRESSOR AMONG CHILD

FEAR – a negative emotional reaction to an imminent danger.

ANXIETY – a negative emotional reaction to undefined things even when there is no immediate danger; subjective
sense of fear
PHOBIA – specific disabling fear
STRESS – any factor that threatens the health of the body; stressor

MANIFESTATION OF FEAR
A. PHYSIOLOGICAL CHANGE
 Goose bumps
 Perspiration
 High heart rate
 High respiratory rate
 Paleness
B. BEHAVIORAL CHANGE
 Thumb sucking
 Nail biting
 Bed wetting
 Avoidance of fear producing object
 Ashamed
COMMON STRESSOR OF CHILDREN
1. Threat to their familiar routine.
2. Illness or injury
3. Friend who are bully
4. School phobia
5. Speech difficulties

CAREGIVER’S ADVICE (GENERAL)

1. Acknowledge your clients’ feelings.
2. Don’t rush the child to overcome the fear or anxiety quickly.
3. Encourage your client to talk his fear or anxiety and listen with empathy.
4. Practice 3 E’s:
 Explain
 Expose
 Explore
5. Be a good model in reacting with fear.
6. Divert your client’s attention and give more outlet activities.
7. Allow your client to have some control with the situation.

FEAR

INFANT TODDLER PRE-SCHOOLER SCHOOLER ADOLESCENT

Stranger Separation Castration anxiety - loss of privacy - fear of body image
anxiety anxiety - fear of - fear of rejection
- fear of dark replacement & - fear of school
- fear of the ghost, displacement performance
mascot or big - fear of
creature abandonment

COMMON ACTIVITIES OF CHILDREN

1. Play
2. Nursery rhyme
3. Puppeteering activity
4. Crafting activity

PLAY – recreational activity enjoyed by children

TYPES OF PLAY

INFANCY TODDLER PRE-SCHOOLER SCHOOLER ADOLESCENT

Solitary Parallel Play Associative/Coop Competitive Play Intellectual

Play (children appear to be erative Play Play
playing together but no (group play with rigid
(playing w/ actual interaction b/w (group play but has rules & regulation to (show mental
his own the toddlers even no rigid rules & follow) capacity to a
body parts) though they are on the regulations) higher degree)
same area)
ADVANTAGES:
INFANCY TODDLER PRE-SCHOOLER SCHOOLER ADOLESCENT
STAGE STAGE
1. Helps develop 1. Helps develop 1. Teach the child the “Competitive pLay” “Intellectual
motor skills motor skills concept of sharing. - grou play with play” - show
2. Promotes 2. Promotes 2. Help them rigid rules & mental capacity
progressive coordination & distinguish reality regulations to to a higher
development of balance to fantasy. follow. degree.
all senses 3. Expression of 3. An opportunity to 1. Develop
3. Promote emotion overcome stress & sportmanship 1. Showcase of
coordination of 4. Helps them satisfy frustration. 2. Physical & menta talents & skills.
body movement curiosity devt. 2. Develops
4. Helps develop 5. Learn new skills & sportmanship
hand-eye abilities 3. Develop
coordination. creativity.
TOYS TOYS
TOYS Different sizes of ball, Puzzle, computer toy, TOYS:
Rattle, squeeze toys, dolls, stuff toys, coloring book, kitchen Skipping rope, roller TOYS:
theaters, crib mobile, building blocks, push & play set, skates, ball game Computer game,
music box, pull toys, wheeled teacher/school game, etc. ball game, etc.
unbreakable mirror, toys, shape sorter, big non-toxic clay, bicycle
etc. puzzle etc.

GENERAL GUIDELINES IN CHOOSING A TOY

1. Match toys with child’s age & ability.

2. Give non-toxic toys.
3. Projectile toy should not be given to prevent eye injury.
4. Be sure that the small part of the toys are attached.
5. Don’t give your children below 10 years old a toy that must be plug to an outlet.
6. All toys must be constructed with sturdy materials.

NURSERY RHYMES- – a simple verses often accompanied by a simple tune for the entertainment & education of
small children.

ADVANTAGES
1. It helps the child with reading comprehension & phonetic awareness
2. It helps them identify familiar words which they can incorporate into their own writing
3. Use to broaden the child’s knowledge of his world.

PEPPETEERING ACTIVITY

PUPPET – a small joined figure or a doll usually moved by hand.

PUPPETEER – operator of the puppet

PUPPETRY – art of making puppet

TYPES
1. Shadow
2. String
3. Rod/Stick
4. Hand
 ADVANTAGES
1. Develops creativity
2. Tools for relaxation
3. Widen the child’s imagination
4. Relieves boredom
5. Practice effective communication
6. It gives the child opportunity to try various role he see in ever changing world.

FACtOrS AFFECTING PUPPETEERING:

1. Humor
2. Voice
3. Improvising
4. Personality
5. Manipulation
6. Human element
7. Emotion
8. Moral lesson
9. Entrance & exit

CRAFTING – a skill or an art of making decorative & useful or functional object by hands

TYPES OF CRAFTING
1. Food crafting- functional art for food.
2. Material crafting- functional art for an object.

ADVANTAGES
1. Helps the child to view the adult world
2. Develop creativity
3. Divert the attention of disabled children from handicapped
4. Opportunity to express individuality

CLIENTS WITH SPECIAL NEEDS:

 Client who needs special technique in care from an adult/ parents/ caregiver.

4 CLASSIFICATIONS:
1. Mentally challenged
2. Physically Challenged
3. Chronically Challenged
4. Blind, deaf & mute

COMMON MENTAL DISORDER

A. ADHD - Attention Deficit Hyperactivity Disorder

 Attention Deficit Disorder
 A neuro-behavioral developmental disorder typically presents itself during childhood & is
characterized by a persistent pattern of inattention and/or hyperactivity, as well as forgetfulness,
poor impulse control and distractibility.
 Considered a persistent & chronic condition for which no medical cure is available.
 Unknown cause.
 3 SUBTYPES OF ADHD:
1. INATTENTIVE TYPE
Sign and Symptoms:
a. Inability to pay attention to details or a tendency to make careless errors in schoolwork or other.
b. Difficulty in sustained attention in tasks or play activities.
c. Apparent listening problems
d. Difficulty following instructions
e. Problem with organization
f. Avoidance or dislike of task that require mental effort.
g. Tendency to lose things like toys, notebooks or homework.
h. Distractibility.
i. Forgetfullness in daily activities

2. HYPERACTIVE-IMPULSIVE TYPE
Sign & Symptoms:
1. Squirming
2. Difficulty remaining seated.
3. Excessive running or climbing
4. Difficulty playing quietly
5. Always seeming to be “on the go”
6. Excessive talking
7. Blurting out answers before hearing the full question.
8. Difficulty waiting for a turn or in line
9. Problems with interrupting or intruding

3. COMBINED TYPE
 Involves a combination of the other 2 types & it is the “most common”.

PROBABLE CAUSE:
 Genetic factors
 Environmental factors
 Social factor

DIAGNOSIS
To be considered for diagnosis:
 Child must display behaviors from one of the 3 subtypes before age 7.
 These behavior must be more severe than on other kids of the same age.
 The behaviors must last for atleast 6 months
 The behavior must occur in negatively affect atleast 2 areas of a child’s life.

OTHER RISK FACTORS

 Smoking during pregnancy
 Premature delivery
 Very low birth weight
 Injuries to the brain at birth

TREATMENT
ADHD cannot be cured, but can be successfully managed.

GOAL IN TREATMENT
 To help the child learn to control his or her own behavior & to help families create a good atmosphere at
home.

CAREGIVER APPROACH
1. Create a routinie
2. Get organized
3. Avoid distractions
4. Limit choices
5. Change your interactions with your client
6. Use goals & rewards
7. Discipline effectively
8. Help yor client discover a talent
9. Assist your client in giving prescribed medicines
10. Ask your client about his favorite food & incorporate stories to increase his appetite & avoid
serving food with too much sugar content.

B. AUTISM - described by Dr. Leo Kanner of the JOhns Hopkins Hospital in 1943.
 Most common condition in a group of developmental disorders known as Autism Spectrum
Disorders (ASD’s).
 Also known “CLASSICAL AUTISM”.
 Characterized by impaired social interaction (hallmark feature of autism), problems with verbal &
non- verbal communication & unusual, repetitive or severely limited activities & interests.
 Males are 4x more likely to have than females
 Can be diagnosed before 3 yrs old.
 Unknown cause, but there are probable cause.

PROBABLE CAUSE OF AUTISM:

 Genetics
 Environment
 Abnormal levels of neurotransmitter in the brain.
 Brain infection
 Insult during pregnancy.

DIAGNOSIS:
Doctors rely on a core group of behaviors for the possiblity diagnosis of autism & these behaviors are:
 Impaired ability to make friends with peers.
 Impaired ability to initiate or sustain a conversation with others.
 Absence or impairment of imaginative & social play.
 Stereotyped, repetitive or unusual use of language.
 Restricted patterns of interest that are abnormal in intensity or focus.
 Pre-occupation with certain objects or subjects.
 Inflexible adherence to specific routines or rituals.

COMMON BEHAVIORAL CHARACTERISTICS

A affect isolation
U Unrelatedness to others
T Twindling
I Inconsistent developmental continuity
S self-injurious behavior
T temper tantrum
I “I & you” apparent confusion
 C Concrete thinking (splinter’s skills)

P perceptual inconsistency
E echolalia
O orderiness
P physical incoordination
L language lack
E excessive activity

TREATMENT
No cure for autism, but there are therapies & intervention to improve some specific symptoms.
 Educational/ behavioral interventions
 Medications - most common - antidepressants.

CAREGIVERS APPROACH
1. Behavioral or Educational Interventions
2. Daily Life therapy or Higashi Approach
3. Floor time
4. Provide undemanding love
5. Provide & maintain familiar environment
6. Assist in prescribed medications
7. Keep any harmful things out reach & out of sight
8. Use letter boards, pictures & other objects to convey ideas & for familiarization.

C. DYSLEXIA - from the Greek words dys (impaired, poor or inadequate) & lexis (words or language)
 Most common learning disability in children, affecting 5% or more of all elementary- age children &
persists throughout life.
 It is a learning disability characterized by problems in reading, spelling, writing, speaking or listening.
 Boys are more affected than girls.

Causes;
 Hereditary
 Localized brain lesion.

TYPES OF DYSLEXIA
1. TRAUMA DYSLEXIA
 Usually occurs after some form of brain trauma or injury to the area of the brain that controls
reading & writing.
 rare
2. PRIMARY DYSLEXIA
 Common in boys
 Dysfunction of, rather than damage to the left side of the brain (cerebral cortex) & does not
change with age.
 Rarely able to read above a fourth-grade level & may struggle with reading, spelling & writing as
adults.

3. SECONDARY OR DEVELOPMENTAL DYSLEXIA

 Caused by hormonal development during the early stages of fetal development.
 Diminishes as the child matures
 Common in boys

SUBTYPES OF DYSLEXIA
 1. SURFACE DYSLEXIA
 Child pronounces word as it is spell.
2. PHONOLOGICAL DYLEXIA
 Cannot recognize & unsound out familiar words.
3. ATTENTIONAL DYSLEXIA
 Fails to identify letters correctly when other letters surround it.
4. NEGLECT DYLEXIA
 Misreads the first or last part of the word.
5. DEEP DYSLEXIA
 Makes semantic errors confusing the word or another related one.

SIGN AND SYMPTOMS:

1. Letter & number reversals - most common warning sign.
2. General disorganization of written work
3. Child may appear uncoordinated & have difficulty with organized sports or games.
4. Difficulty with left & right
5. Difficulty moving to the rhythm of the music
6. Difficulty copying from the board or book,
7. Difficulty remembering or understanding what he hears.
8. Parts of words or parts of whole sentences may be missed
9. Late speech development
10. Reading & writing very slowly (slow learner)
11. Difficulty remembering names with colors

DIAGNOSIS
 Difficult to diagnose
 The testing determines the child’s functional reeading level & compares it to reading potential which
is evaluated by an intelligence test.
TREATMENTS
No actual cure

CAREGIVER APPROACH
1. Give the child plenty of time with any reading
2. Teach your client to pronounce word correcty
3. Concentrate on what the child is good at
4. Incorporate multi sensory techniques
5. Do not compare one child with the other.

D. MENTAL RETARDATION - a.k.a “slow learners”

 Generalized disorder characterized by sub average cognitive funtioning & deficits in two or more adaptive
behaviors with onset before the age of 18.
 Synonymous with intellectual disability & cognitive disability
 Significant limitation in daily living skills
 IQ score below 70-75.

CAUSES:
 Down syndrome, fetal alcohol syndrome & fragile X - most common inborn causes.
 Genetic conditions
 Problems during pregnancy
 Problems at birth (ex. Lack of oxygen)
 Health problems (sick, asthma)
 Iodine deficiency (folic acid for brain development)
 Malnutrition
 SIGNS & SYMPTOMS
1. Have trouble in speaking
2. Find it hard to remember things
3. Have trouble in undrstanding social rules
4. Have trouble discerning cause & effect
5. Have trouble solving problems
6. Have trouble thinking logically
7. Persistence of infantile behavior

LEVEL OF MENTAL RETARDATION

1. BORDERLINE
 IQ 70-79
2. MILD
 Moron
 Mental age 8-12 yrs old
 Educable
 IQ 50-69
3. MODERATE
 Imbecile
 Mental age 3-7 yrs old
 Trainable
 IQ 35-49
4. SEVERE
 Idiot
 Mental age; 1-2 yrs old
 IQ 20-34
5. PROFOUND
 Profound
 Mental age; infant
 No communication at all needs 24 hrs supervision
 IQ below 20

DIAGNOSIS
It is formally diagnosed by professional assessment of intelligence & adaptive behavior.

TREATMENT
There is NO cure.

CAREGIVER APPROACH
1. Always deal with the child development & not chronological age.
2. Promote safety & security
3. Promote independence
4. Due to limited attention span, present a smaller amount of material to him at s slower rate & longer
period of time.
5. Employ techniques of positive re-enforcement.

E. DOWN SYNDROME - a.k.a “TRISOMY 21”

 A genetic condition caused by an extra genetic material (genes) from the 21st chromosome that would
lead to mental retardation and other problems.
 The condition varies in severity, so developmental problems may range from mild to serious.
 The condition is named after John Langdon Down, the doctor who first identified the syndrome
 There’s no medical cure for this condition. But increased understanding of Down syndrome and early
interventions make a big difference in the lives of both children and adults with Down syndrome.

EPIDEMIOLOGY
 Most common genetic cause of severe learning disabilities in children.
 One in every 700 infants
 Every year, as many as 6,000 babies are born with Down Syndrome in the United states.

RISK FACTORS
1. Advancing maternal age
 As a woman’s eggs age, there’s a greater inclination for chromosomes to divide improperly. So a
woman’s chances of giving birth to a child with Down syndrome increase with age.
 By age 35, a woman’s risk of conceiving a child with Down syndrome is in 1 in 385.
 By age 40, the risk is 1 in 106
 By age 45, the risk is 1 in 30.
 However, most children with Down syndrome are actually born to women under age 35 because this
younger group of women has far more babies.
2. Mothers who already have one child with Down syndrome.
 Typically, a woman who has one child with Down syndrome has about a 1% chance of having
another child with down syndrome
3. Parents who are carriers of the genetic translocation for Down Syndrome.
 Both men and women can pass the genetic translocation for Down syndrome on to their children.

CAUSES AND TYPES:

A. TRISOMY 21
 More than 90 percent of cases of Down syndrome are casued by trisomy 21.
 A child with trisomy 21 has copies of chromosomes 21, instead of the usual two copies, in all of his or
her cells.
 Caused by abnormal cell division during the development of the sperm cell or the egg cell.
B. MOSAIC DOWN SYNDROME
 Rare form of Down syndrome
 Children have some cells with an extra copy of chromosomes 21, but not all
 This mosaic of normal and abnormal cells is caused by abnormal cell division after fertilization.
C. TRANSLOCATION DOWN SYNDROME
 Can occur when part of chromosome 21 becomes attached (translocated) onto another chromosome,
before or at conception
 They usually have two copies of chromosomes 21, but they also have additional material from
chromosome 21 stuck to the translocated chromosome.
 This form of Down syndrome is uncommon.
 The only form of the disorder that can be passed from parent to child
 Only about 4 percent of children with Down Syndrome have translocation.

CLINICAL FEATURE
A. Common dysmorphic facial features:
 Flat facial profile
 Short, upslanting palpebral fissures
 Brushfiled spots
 Flat nasal bridge with epicanthal folds
 Small mouth with protruding tongue
 A small retroplaced chin.
 Short ears with abnormal earlobes that are usually downfolded.
B. Other dysmorphic features:
 Microcephaly
 Flat occiput (brachycephaly)
 Excess posterior neck skin
 Short structure
 Short sternum
 Small genitalia
 Shorts hands and fingers
 Single palmar crease (simian creases)
 Gap between the first and second toes
 Balding scalp hair pattern
C. Functional and structural abnormalities:
 Hypotonia
 Cardiac defects (subendocardial cushion defects and septal defects: ASD/ VSD)
 Gastrointestinal abnormalities (duodenal atresia, imperforate anus and Hirschsprung disease)
 Developmental delay and mental retardation (IQ range of 35-65 with a mean of 54)
 Hypothyroidism
 Leukemia
 Dementia
 Joint laxity
 Atlantoaxial intability

TEST AND DIAGNOSIS

Screening tests during pregnancy:
A. ULTRASOUND
 The doctor uses ultrasound to measure a specific region on the back of a baby’s neck
 This is known as a nuchal translucency screening test.
 When abnormalities are present more fluid than usual tends to collect in this issue.
B. BLOOD TESTS
 Blood tests that measure levels of pregnancy associated plasma protein - A (PAPP-A) and a hormone
known as human chorionic gonadotropin (HCG).
 Abnormal levels of PAPP-A and HCG may indicate a problem with the baby.
Diagnostic test during pregnancy:
A. AMNIOCENTESIS
 A sample of the amniotic fluid surrounding the fetus is withdrawn through a needle inserted into the
mother’s uterus.
 This sample is then used to analyze the chromosomes of the fetus.
 Doctors usually perform this test after 15 weeks of gestation.
 The test carries a risk of miscarriag of one in 200.
B. CHORIONIC VILLUS SAMPLING (CVS)
 Cells taken form the mother’s placenta can be used to analyze the fetal chromosomes.
 Typically performed beetween the ninth and 14th week of pregnancy.
 This test carries a risk of miscarriage of one in 100.
C. PERCUTANEOUS UMBILICAL BLOOD SAMPLING(PUBS)
 Blood is taken fro a vein in the umbilical cord and examined for chromosomal defects.
 Doctors generally perform this test after 18 weeks of gestation.
 This test carries a greater risk of miscarriage than does amniocentesis or chorionic villus sampling
 Generally, this test is only a done when speed of diagnosis is essential.

DIAGNOSTIC TEST FOR NEWBORNS:

 After birth, the inital diagnosis of Down syndrome is often based on the baby’s
appearance
 If your child displays some or all of the characteristics of Down syndrome, your
doctor will probably order a test called a “Chromosomal karyotype”.
  Chromosomal karyotype is a test that analyzes the child’s chromosomes. If there’s
an extra chromosomes 21 present in all or some of the cells, diagnosis is Down
Syndrome.

CAREGIVER APPROACH
1. Assist in ADLS (feeding, dressing, personal hygiene)
2. Give excercise (ROME) based on the client’s capabilities.
3. Assist in taking medications and in doctor’s appointments if the parent is not around.
4. Foster the child’s independence
5. Provide activities that would stimulate the child (like playing puzzle and ball)

F. CEREBRAL PALSY - a disorder of movement and posture that results from a non-progressive lesion or
injury of the immature brain.
 It include a heterogenous spectrum of clinical syndromes characterized by alteration in muscle tone, deep
tendon reflexes, primitive reflexes, and postural reactions. (spasticity/ spastic -increase of muscle tone)
 Cerebral palsy isn’t curable; however, getting the right therapy could make a big difference.
 A.ka Little Disease (flaccidity/ flaccid - decrease of muscle tone)

EPIDEMIOLOGY
 Most common disability affecting children.
 2-3 per 1000 live births.

ETIOLOGY
 Currently, the most common causes are related to brain injury occuring in children born prematurely.
 Prenatal
a. Congenital Malformations
b. Socioeconomic factors
c. Maternal intrauterine infection
T oxoplasmosis
O thers (syphilis, mumps, gonorrhoea, hepa B, HIV, etc.)
R ubelia (tigdas)
C ytomegalo virus
H erpes simplex
d. Reproductive inefficiency
e. Toxic or teratogenic agents
f. Maternal mental retardation, seizures, hyperthyroidism
g. Placental complications
h. Abdominal trauma
 Neonatal
a. Prematurity <32 weeks’ gestation
b. Birth weight <2500 gm
c. Growth retardation
d. Abnormal presentations
e. Intracranial hemorrhage
f. Trauma
g. Infection
h. Bradycardia and hypoxia
i. Seizures
j. Hyperbilirubenia (increase in redness- bail)

 Postnatal
a. Trauma
b. Infection (hydrocephalus, meningo)
 c. Intracranial hemorrhage
d. Coagulopathies

MAJOR FINDINGS IN CEREBRAL PALSY:

1. Alteration in muscle tone
2. Alteration in deep tendon reflex.
3. Abnormal reflexes (presence of primitive reflexes)
4. Altered postural reactions
5. Delayed motor development

CLASSIFICATION OF CEREBRAL PALSY

 Often characterized by the type of muscle tone abnormality and the body parts involved.
 The most common abnormality Is that of increased muscle tone, or spasticity (3/4 of all patients with
CP)
 Less common are dyskinetic disorders with involuntary movements.
a. By tone abnormalities
1. Spastic
 An increase in muscle tone
 Hyperreflexia
 Clonus (newborns may normally have a few beats of clonus)
2. Dyskinetic
 A collective term for several movement disorders.
 Secondary to abnormal regulation of tone defects in posturak control and
coordinate deficits.
i. Athetoid
 Slow, writhing, involuntary, movement particularly in the distal extremities.
 Intensity may increase with emotions and purposely activity.
ii. Chorea
 Abrupt , irregular, jerky movements usually occurring in the head, neck and
extrimities.
iii. Choreathetoid
 Combination of athetosis and choreiform movements.
 Generally large amplitude involuntary movements.
 Dominating pattern is the athetoid movements.

iv. Dystonia
 Slow, rhythmic movements with tone changes
 Generally found in the trunk and extremities.
 Abnormal posture
v. Axatic
 Unsteadiness with uncoordinated movements.
3. Hypotonic
 Diminished muscle tone
4. Mixed
 Includes descriptions from both spastic and dyskinetic classification.
b. By body parts involved
1. Monoplegia - one limb, either an arm or leg.
2. Diplegia - the lower limbs are more affected than the upper limbs.
3. Triplegia - three extremities involved
4. Quadriplegia - all four limbs are affected.
5. Hemiplegia - one side of the body is involved more than the other, and the arm usually
is affected more than the leg.
 CAREGIVER APPROACH
1. Assist in ADLS (feeding, dressing, personal hygiene).
2. Give excercise (ROME) based on the clients’s capabilities.
3. Assisist in ambulation
4. Assist in taking medications and in doctor’s appointments if the parent is not around
5. Foster the child’d independence
6. Provide activities that would stimulate the child.

VARIOUS DISEASES :
A. POLIOMYELITIS
 Acute infection cause by a group of enterovirus that attack the anterior all of the nervous system.

3 MOST COMMON POLIO VIRUS:

1. BRUNHILDE - most common , most paralytic
2. LANSING - 2nd most common & paralytic
3. LEON- least common & least paralytic

MODE OF TRANSMISSION:
 ORO-fecal route
 Incidence (4-6 yr/o)

COMPLICATIONS:
- Paralysis
- post polio syndrome

TYPES OF VACCINE:
a. OPV (Oral-Polio Vaccine) a.k.a “SABIN VACCINE”
b. IPV (Injectable -Polio Vaccine) a.k.a “salk vaccine”

CGA:
1. Provide proper hygiene and maintain good sanitation of the enviroment.
2. Proper nutrition
3. Range of motion exercises
4. Provide comfort & assist on medication
5. Maintain good body.

B. LEUKEMIA
 a.k.a “Cancer of the Blood”
 Most common type of cancer among children
 Characterized by over production of white blood cell.

TYPES OF BLOODCELLS:
a. WBC (White Blood Cells)- Leukocyte; known as thesoldier of the body which fights infection
of foreign organism
b. RBC (Red Blood Cells) - Erythrocyte; carries oxygen & other nutrients that is distributed to
different body parts.
c. PLATELETS (Thrombocyte) - responsible for clotting mechanism to prevent hemorrhage.

MEDICAL TREATMENT:
1. Chemotherapy
2. Bone marrow transplant
 CGA:
1. don’t pretend the disease does not exist
2. don’t give false hope
3. Use toothbrush with soft bristles.
4. Prepare food rich in iron
5. don’t tell others, about the client’s condition
6. don’t let your client play too much
7. Be supportive in all medical procedure.

PROCEDURE IN BATHING AN INFANT

4 major considerations before bathing an infant:

1. Check the temperature of the baby – it should be normal b/w 36.5 C – 37.5 C.
2. Control the environment – close all the windows & doors & turn off the air conditioning unit in the
bathing area to prevent the baby from having common colds.
3. Availability of materials – to save time & energy & avoid inconvenience
4. Readiness of the caregiver
 should know the bathing procedure
 should not be sick
 should remove the jewelries & trim nails to avoid harming the baby
 should wear an apron to avoid from getting soaked

STEPS:
1. Remove the soiled diaper, discard it properly - clean the buttocks, using cotton ball, soak
in water.
2. Check the temperature of the baby - using the anal method in temp. Taking, if the temp., is within
normal range proceed to bathing, it its above render tepid sponge bath only
3. Undress the baby- use swaddling cloth to cover the body
4. Check the water temperature- using your hand or elbow, the temperature should be optimal
5. Hold the baby in Football hold position- cover the ears with use of thumb and middle finger, to
avoid water into the ears.
6. Clean the head
 by splashing water on it,
 lather your hand with mild shampoo and apply on the baby’s head in gentle circular motion from
top of the head to the back paying attention particularly the back of the ears.
 Rinse off
 Pat it dry
7. Bring the baby back to the rubber mat and start cleaning the face
 Use a cotton cloth formed into a mitten dip into the water, do not use soap on the face because
it is sensitive.
 Use the Z, A or 3 technique
8. Clean the eyes - Using your thumb, dip it in water and start cleaning from inner part near the nose
bridge to the outer part gently in one stroke only, then pat it dry
9. Expose upper extrimities
 Splash with water
 Apply mild soap to the body paying attention to the neck, armpit, the creases and folds of the
arm & forearm & the interdigital spaces of the fingers.
 Rinse hands immediately to avoid soap getting into the mouth once the beby start sucking on
them.
10. Cover the umbilical cord - using a strerile gauze
11. Expose the lower extrimities-
 Splash with water
 Lather your hand with mild soap, apply it on the groin, the thigh, back of the knees ang legs and
the interdigital spaces of toes
12. Put the baby in a side lying position to clean the back
 Splash with water
 Apply mild soap on the back, from the nape, the middle part of the back down to the buttocks
 Bring the baby back to original position
13. Clean the genital area
 If baby boy
o Splash w/water
o Get a cotton ball, soak in water
o Start cleaning from tip, down to the shaft then scrotum
 If baby girl
o Get a cotton ball, soak in water
o Do the 7-stroke (1 stroke from the upper part of vagina to the right side, to the left, to the
middle) use many cotton balls as much as you want until the area is already clean.
14. Final rinse
 Hold the baby in a football hold position
 Cover the ears
 Make sure the upper extremity is lower than the foot to avoid wetting the umbilical cord
 Splash with water
 Immerse the lower extremity
 Then the back
15. Get a clean towel then pat dry the body
 Now this is the ideal time to do some massage
 Ask your employer if you’re going to use lotion, powder or oil
o Powder – apply away from the baby’s face to avoid some allergic reaction on it
o Lotion/Oil – direction should be against the pores for better absorption
o Do twist & turn massage – start with both hands, legs, for the chest (do I love u
massage) for stomach (sadden moon)
16. Dress the baby
 Clean the umbilical area
o Get a cotton ball
o Soak in alcohol, betadine solution from inner to outer part
o Then cover, close the diaper & dress
17. Put on the diaper- fold the diaper using butterfly fold technique
18. Clean the mouth, nose & ears
 Mouth
o Get a clean cloth, put into smallest finger in an inverted J-stroke (from inner to outer),
clean also the palate & massage gums
 Nose (external part only)
o Get a cotton bud, one tip of the cotton bud to each side
 Ears (external part only)
o Get a cotton bud, one tip of the cotton bud to each side
19. Remove your apron and feed the baby
 check the temperature of themilk formula before feeding.
 Maintain eye to eye contact to promote bonding and to make sure that the baby is sucking on
the nipple correctly
20. Burp the baby midway and after feeding
 when the baby fall asleep put him in a side lying position inside the crib to prevent aspiration,
suffocation and SIDS
Warnings:
 After bathing the baby you can cleanyour mess and do other chores but don’t forget to check
the baby from time to time.
 Never leave a baby unattended in the bath, even for a few seconds. Infants can drown in
very shallow water.

STERILIZATION OF FEEDING BOTTLES

1. Before you sterilize, you’ll need to clean the used bottles thoroughly. Wash the bottles with clean soapy
water, along with teats, retaining rings & caps.
2. Place the clean bottles, teats, caps & utensils in a large saucepan/sterilizer on the back burner of the stove.
3. Add enough water to cover all equipment, making sure there are no air bubbles. (2/3 of feeding water)
4. Bring water to the boil.
5. Wait for 15 mins. Before removing the teats.
6. Put on a low fire for another 15 mins.
7. Turn off the stove & allow water to cool down.

PREPARE MILK FORMULA

1. Pour the correct amount of water into the bottle.
2. Gently fill the scoop w/ formula – according to the pediatrician’s prescription
3. Holding the edge of the treat with your clean hands, put it on the bottle.
4. Cover the treat with the cap & shake the bottle until the powder is dissolved.
5. It is important to cool the formula so it is not hot to drink. Do this by holding the bottom half of the bottle
under cold running water.
6. Test the temperature of the infant formula on the side of your wrist before giving it to your baby.

FEEDING THE BABY

1. Shake it sideways/8 technique/circular
2. Open a little to release the air
3. Then, check the temperature (side of your wrist)
4. Carry the baby into a cradle hold position (tummy -to-tummy)
5. Start feeding the baby
6. Make an eye-to-eye contact with the baby to promote bonding
7. Make sure that the baby is sucking the nipple correctly.

BURPING (BURP MIDWAY & AFTER FEEDING)

1. Get a clean cloth, put it on your shoulder
2. Position the baby into burping position
3. Make sure the chin is resting on your shoulder
4. The face is away from your neck to prevent suffocation
5. Do downward chopping massage at the back
6. Then continue feeding
7. After feeding, again position the baby into burping position (repeat procedure) wait until baby burps
8. Assuming the baby is asleep, put the baby into side lying position to prevent suffocation, aspiration & SIDS.

 After bathing the baby, you can clean your mess & do household chores but don’t forget the baby from time
to time.
 Never leave the baby unattended in the bath, even for a few seconds. Infants can be drowning in very
shallow water.